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General NPI Number Information
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NPI Number | 1063471142
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Entity Type | Individual
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Provider Name | RANDY LEE BIGGERSTAFF ATC
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Gender | Male
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Dates
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Enumeration Date | 03/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 209 S KINGSHIGHWAY ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-1693
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Country | US
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Telephone | 636-949-4683
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Fax | 636-949-4636
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Provider Business Mailing Address
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Address Line | PO BOX 6 200 FORD STREET
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City | GRAY SUMMIT
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State | MO
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Zip | 63039-0006
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Country | US
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Telephone | 636-742-2738
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Fax | 636-949-4636
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 00014
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License Number State | MO
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